Provider Demographics
NPI:1518528959
Name:EMERALD LEAF COUNSELING LLC
Entity Type:Organization
Organization Name:EMERALD LEAF COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOERDT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-829-6350
Mailing Address - Street 1:2916 LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1405
Mailing Address - Country:US
Mailing Address - Phone:703-829-6350
Mailing Address - Fax:
Practice Address - Street 1:5275 LEE HWY STE 104
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1619
Practice Address - Country:US
Practice Address - Phone:703-829-6350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty